The governors John Kasich of Ohio, John Hickenlooper of Colorado, Brian Sandoval of Nevada, Tom Wolf of Pennsylvania, Bill Walker of Alaska, Terence R. McAuliffe of Virginia, John Bel Edwards of Louisiana, and Steve Bullock of Montana sent a letter to the Republican and Democratic leaders of the House and Senate asking them to take immediate steps to restore insurance markets stabilization structures.

The letter was sent ahead of the testimony governors are expected to offer to the Senate Health, Education, Labor, and Pensions committee on September 7.

The immediate steps recommended by the governors include:

Funding cost-sharing reduction payments;

Creating a temporary stability fund;

Offer choices in under-served counties;

Keep the individual mandate, for now.

The governors also suggest additional steps that states could take and Congress could facilitate to encourage market stability. These include:

Maximize market participation;

Maximize carrier participation

Waive exchange fees for carriers who are the last remaining carrier in a county

Encourage participation across lines of business (Medicaid MCO, state employee, etc.)

Pursue strategies to create larger, more stable pools (e.g., consider combining individual
and small group markets, or consider combining Medicaid and marketplace populations)

Reduce cost through coverage redesign and and payment innovation;

Apply for a State Innovation Waiver to pursue innovative strategies to strengthen health insurance markets while retaining the basic protections of the ACA. Section 1332 of the ACA allows a state to request permission to waive provisions related to individual and employer mandates, qualified health plans, consumer choices and insurance competition through marketplaces, and premium tax credits and cost-sharing reductions in the marketplace provided that state covers as many people with coverage that is as affordable and as comprehensive without adding to the federal deficit.

Encourage the adoption of population-based payment models that reward the effective management of total cost of care

Encourage the adoption of episode-based payment models that reward the effective management of specialty care

Enable the use of value-based insurance design and wellness incentives to tie the level of coverage for chronic care to personal responsibility for health outcomes achieved

Increase transparency in cost and quality (e.g., promote the use of consumer facing websites, include ERISA plan data in all payer claims databases)

"BHM provides consultation and direct clinical oversight to East Carolina Behavioral Health as a delegated authority for clinical peer review and physician services. We have been extremely satisfied, and value the organization’s depth and breadth of knowledge. BHM continues to exceed our expectations."

Cindy Ehlers,
V P Clinical Operations, Trillium (formerly ECBH)

"6 of the top 10 largest health plans* entrust BHM for behavioral health peer reviews.